Progress, however incremental, is worth noting.
A study published
in December in the New England Journal of
Medicine (NEJM) examining the quality and equity of hospital care in the
first six years of the CMS Hospital Inpatient Quality Reporting program
observed increased racial and ethnic equity in process-of-care measures for
white, black, and Hispanic adults hospitalized for heart attack, heart failure,
or pneumonia between 2005 and 2010. These reductions were seen among patients
treated in the same hospital as well as between hospitals, “indicating greater
improvement among hospitals that disproportionately serve minority patients.”
The authors note
that “the foundation of quality improvement rests on reducing inappropriate
variations in care,” and suggest that improving the consistency of care
delivery could reduce variations due to patients’ race or ethnicity.
Meanwhile,
the 2015 National Impact Assessment of
the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report
assessed 25 CMS reporting programs using data from 2006 to 2013. Looking at
trends in provider performance rates across seven programs from 2006 to 2012
specifically, the report found that widespread race and ethnicity disparities
were “much less pronounced” in 2012 than in the beginning of the study period,
even though disparities continue across some programs, settings, and
demographic groups.
In
an editorial in December’s NEJM, Marshall Chin, MD, MPH, of the
University of Chicago, cautions, however, that inpatient processes “represent a
narrow slice of time and depend on the technical actions of the healthcare team
rather than on patients.” He writes that eliminating disparities will require
“truly patient-centered care” individualized for patients by clinicians who
appreciate the social and economic factors that influence health outcomes, and
calls for aligning payment incentives to support reductions in disparities.
Chin
voices support for risk adjusting clinical performance scores for patients’
socioeconomic status to “create a level playing field in pay-for-performance
programs.” The National Quality Forum is leading the national dialogue on this
issue, and a two-year trial is underway to assess the impact of risk adjusting
measures for socioeconomic status and other demographic factors. Chin
served on an NQF committee that examined the issue of risk adjustment for
socioeconomic status or other sociodemographic factors. The committee’s recommendations
are the basis of the trial underway today.
